急性缺血性脑卒中患者早期活动循证实践方案的构建与应用
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摘要
目的 :构建急性缺血性脑卒中患者早期活动循证实践方案并评价应用效果。方法 :基于证据、临床情境比较和患者需求分析结果,形成急性缺血性脑卒中患者早期活动实践方案,并将证据整合成为临床实践流程。结果 :39名脑卒中患者接受了早期活动干预,患者入院后早期活动开始时间提前,入院24小时内早期活动实施率提高,卒中后14天的照护结局改善,平均住院日缩短。结论 :通过构建与应用急性缺血性脑卒中患者早期活动循证实践方案,可以更有效地促进卒中患者早期活动的实施,改善患者照顾结局,提升护理品质。
Objective: To construct and evaluate the evidence-based early mobilization protocol for patients with acute ischemic stroke. Methods: An evidence-based early mobilization protocol for patients with acute ischemic stroke was developed and integrated into clinical practice based on evidence, clinical scenarios, and patients need. Results: Totally 39 ischemic stroke patients received tailored intervention. The start time of mobilization after admission was reduced, the rate of early mobilization within 24 hours was increased, the outcome after 14 days of stroke was improved, shortened the length of hospital stay. Conclusion: The construction and application of evidence-based early mobilization protocol may facilitate the implementation of early mobilization, improve outcomes of stroke patient, and enhance nursing quality.
Objective: To construct and evaluate the evidence-based early mobilization protocol for patients with acute ischemic stroke. Methods: An evidence-based early mobilization protocol for patients with acute ischemic stroke was developed and integrated into clinical practice based on evidence, clinical scenarios, and patients need. Results: Totally 39 ischemic stroke patients received tailored intervention. The start time of mobilization after admission was reduced, the rate of early mobilization within 24 hours was increased, the outcome after 14 days of stroke was improved, shortened the length of hospital stay. Conclusion: The construction and application of evidence-based early mobilization protocol may facilitate the implementation of early mobilization, improve outcomes of stroke patient, and enhance nursing quality.
引文
[1] Langhorne P, Collier J M, Bate P J, et al. Very early versus delayed mobilisation after stroke.Cochrane Database Syst Rev, 2018(10):D6187.
[2] Gao Y, Jiang B, Sun H, et al. The burden of stroke in China:results from a nationwide population-based epidemiological survey. PLoS One, 2018,13(12):e208398.
[3] Li Z, Zhang X, Wang K, et al. Effects of early mobilization after acute stroke:a Meta-analysis of randomized control trials. J Stroke Cerebrovasc Dis, 2018,27(5):1326-1337.
[4]王清,沈小芳,陈湘玉.超早期活动对急性脑卒中患者康复及卒中后抑郁的影响.护理学报,2015(22):30-34.Wang Q, Shen XF, Chen XY. Influence of superearly activities after actue stroke on recovery and indience of post-stroke depression. Journal of Nursing(China), 2015(22):30-34.
[5] Wen ZW, Sally S, Leonid C, et al. Stroke rehabilitation in China:a systematic review and Meta-analysis. International Journal of Stroke,2014,9(4):494-502.
[6] Sjoholm A, Skarin M, Linden T, et al. Does evidence really matter? Professionals'opinions on the practice of early mobilization after stroke. J Multidiscip Healthc, 2011(4):367-376.
[7] Wellwood I, Langhorne P, Mckevitt C, et al.An observational study of acute stroke care in four countries:the European registers of stroke study.Cerebrovasc Dis, 2009,28(2):171-176.
[8] van Wijk R, Cumming T, Churilov L, et al.Anearlymobilizationprotocolsuccessfully delivers more and earlier therapy to acute stroke patients:further results from phase II of AVERT.Neurorehabil Neural Repair, 2012,26(1):20-26.
[9]张晨,田丽.改良早期预警评分与校正改良预警评分在外科术后患者中的应用对比研究.天津护理,2014,22(1):4-6.Zhang Z, Tian L. Application of modified early warning score and calibrated modified early warning score in surgical in-patients. Tianjin Journal ofNursing, 2014,22(1):4-6.
[10]王清,沈小芳.超早期活动对急性脑卒中病人负性情绪的影响.护理研究,2016,30(9B):3237-3275.Wang Q, Shen XF. Influence of very early mobilization on the negative emotion of patients with acute stroke. Chinese Nursing Research,2016,30(9B):3237-3275.
[11] Bernhardt J, Churilov L, Ellery F, et al.Prespecified dose-response analysis for A Very Early Rehabilitation Trial(AVERT). Neurology,2016,86(23):2138-2145.
[12]李红丽,王清.急性缺血性脑卒中患者家属参与早期活动方案的研究.护理学杂志,2016,31(21):31-34.LiHL,WangQ.Developmentofafamilyinvolved early mobilization regiment for ischemic stroke. Journal of Nursing Science, 2016,31(21):31-34.
[13]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014.中华神经科杂志,2015,48(4):246-257.Chinese Society of Neurology, Cerebrovascular Disease Group of Chinese Society of Neurology.Chinese guideline for diagnosis and treatment of acute ischemic stroke 2014. Chinese Journal of Neurology, 2015,48(4):246-257.
[14] Feigin V L, Norrving B, Mensah G A. Global burden of stroke. Circ Res, 2017,120(3):439-448.
[15] Ost N A, Eriksson G, Johansson U, et al.Experiences of the return to work process after stroke while participating in a person-centred rehabilitation programme. Scand J Occup Ther,2017,24(5):349-356.
[16]中华医学会神经病学分会,中华医学会神经病学分会神经康复学组,中华医学会神经病学分会脑血管病学组.中国脑卒中早期康复治疗指南.中华神经科杂志,2017,50(6):405-412.Chinese Society of Neurology, Neurological Rehabilitation Group of Chinese Society of Neurology, Cerebrovascalar Disease Group of Chinese Society of Neurology. Chinese guideline for rehabilitation and treatment of acute ischemic stroke. Chinese Journal of Neurology,2017,50(6):405-412.
[17] Winstein CJ, Stein J, Arena R, et al.Guidelines for adult stroke rehabilitation and recovery:a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2016,47(6):98-169.
[18] Coleman ER, Moudgal R, Lang K, et al. Early rehabilitation after stroke:a narrative review. Curr Atheroscler Rep, 2017,19(12):59.
[19] Yelnik AP, Quintaine V, Andriantsifanetra C, et al. Active mobility very early after stroke:a Randomized Controlled Trial. Stroke, 2017,48(2):400-405.
[20] Duhamel F. Translating knowledge from a family systems approach to clinical practice:insights from knowledge translation research experiences. J Fam Nurs, 2017,23(4):461-487.
[21] Svavarsdottir EK, Sigurdardottir AO,Konradsdottir E, et al. The process of translating family nursing knowledge into clinical practice. J Nurs Scholarsh, 2015,47(1):5-15.
[22]HimiN,TakahashiH,OkabeN,etal.Exercise in the early stage after stroke enhances hippocampal brain-derived neurotrophic factor expression and memory function recovery. J Stroke Cerebrovasc Dis, 2016,25(12):2987-2994.
[23]许素环,史俊杰,但鑫,等.急性脑卒中患者超早期活动干预效果的Meta分析.中国护理管理,2018,18(6):748-754.Xu SH, Shi JJ, Dan X, et al. The effect of very early mobilization in acute stroke patients:a Meta-analysis. Chinese Nursing Management,2018,18(6):748-754.
[2] Gao Y, Jiang B, Sun H, et al. The burden of stroke in China:results from a nationwide population-based epidemiological survey. PLoS One, 2018,13(12):e208398.
[3] Li Z, Zhang X, Wang K, et al. Effects of early mobilization after acute stroke:a Meta-analysis of randomized control trials. J Stroke Cerebrovasc Dis, 2018,27(5):1326-1337.
[4]王清,沈小芳,陈湘玉.超早期活动对急性脑卒中患者康复及卒中后抑郁的影响.护理学报,2015(22):30-34.Wang Q, Shen XF, Chen XY. Influence of superearly activities after actue stroke on recovery and indience of post-stroke depression. Journal of Nursing(China), 2015(22):30-34.
[5] Wen ZW, Sally S, Leonid C, et al. Stroke rehabilitation in China:a systematic review and Meta-analysis. International Journal of Stroke,2014,9(4):494-502.
[6] Sjoholm A, Skarin M, Linden T, et al. Does evidence really matter? Professionals'opinions on the practice of early mobilization after stroke. J Multidiscip Healthc, 2011(4):367-376.
[7] Wellwood I, Langhorne P, Mckevitt C, et al.An observational study of acute stroke care in four countries:the European registers of stroke study.Cerebrovasc Dis, 2009,28(2):171-176.
[8] van Wijk R, Cumming T, Churilov L, et al.Anearlymobilizationprotocolsuccessfully delivers more and earlier therapy to acute stroke patients:further results from phase II of AVERT.Neurorehabil Neural Repair, 2012,26(1):20-26.
[9]张晨,田丽.改良早期预警评分与校正改良预警评分在外科术后患者中的应用对比研究.天津护理,2014,22(1):4-6.Zhang Z, Tian L. Application of modified early warning score and calibrated modified early warning score in surgical in-patients. Tianjin Journal ofNursing, 2014,22(1):4-6.
[10]王清,沈小芳.超早期活动对急性脑卒中病人负性情绪的影响.护理研究,2016,30(9B):3237-3275.Wang Q, Shen XF. Influence of very early mobilization on the negative emotion of patients with acute stroke. Chinese Nursing Research,2016,30(9B):3237-3275.
[11] Bernhardt J, Churilov L, Ellery F, et al.Prespecified dose-response analysis for A Very Early Rehabilitation Trial(AVERT). Neurology,2016,86(23):2138-2145.
[12]李红丽,王清.急性缺血性脑卒中患者家属参与早期活动方案的研究.护理学杂志,2016,31(21):31-34.LiHL,WangQ.Developmentofafamilyinvolved early mobilization regiment for ischemic stroke. Journal of Nursing Science, 2016,31(21):31-34.
[13]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014.中华神经科杂志,2015,48(4):246-257.Chinese Society of Neurology, Cerebrovascular Disease Group of Chinese Society of Neurology.Chinese guideline for diagnosis and treatment of acute ischemic stroke 2014. Chinese Journal of Neurology, 2015,48(4):246-257.
[14] Feigin V L, Norrving B, Mensah G A. Global burden of stroke. Circ Res, 2017,120(3):439-448.
[15] Ost N A, Eriksson G, Johansson U, et al.Experiences of the return to work process after stroke while participating in a person-centred rehabilitation programme. Scand J Occup Ther,2017,24(5):349-356.
[16]中华医学会神经病学分会,中华医学会神经病学分会神经康复学组,中华医学会神经病学分会脑血管病学组.中国脑卒中早期康复治疗指南.中华神经科杂志,2017,50(6):405-412.Chinese Society of Neurology, Neurological Rehabilitation Group of Chinese Society of Neurology, Cerebrovascalar Disease Group of Chinese Society of Neurology. Chinese guideline for rehabilitation and treatment of acute ischemic stroke. Chinese Journal of Neurology,2017,50(6):405-412.
[17] Winstein CJ, Stein J, Arena R, et al.Guidelines for adult stroke rehabilitation and recovery:a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2016,47(6):98-169.
[18] Coleman ER, Moudgal R, Lang K, et al. Early rehabilitation after stroke:a narrative review. Curr Atheroscler Rep, 2017,19(12):59.
[19] Yelnik AP, Quintaine V, Andriantsifanetra C, et al. Active mobility very early after stroke:a Randomized Controlled Trial. Stroke, 2017,48(2):400-405.
[20] Duhamel F. Translating knowledge from a family systems approach to clinical practice:insights from knowledge translation research experiences. J Fam Nurs, 2017,23(4):461-487.
[21] Svavarsdottir EK, Sigurdardottir AO,Konradsdottir E, et al. The process of translating family nursing knowledge into clinical practice. J Nurs Scholarsh, 2015,47(1):5-15.
[22]HimiN,TakahashiH,OkabeN,etal.Exercise in the early stage after stroke enhances hippocampal brain-derived neurotrophic factor expression and memory function recovery. J Stroke Cerebrovasc Dis, 2016,25(12):2987-2994.
[23]许素环,史俊杰,但鑫,等.急性脑卒中患者超早期活动干预效果的Meta分析.中国护理管理,2018,18(6):748-754.Xu SH, Shi JJ, Dan X, et al. The effect of very early mobilization in acute stroke patients:a Meta-analysis. Chinese Nursing Management,2018,18(6):748-754.